The Centers for Disease Control and Prevention (CDC) published a Notice to Readers titled "Update on the Supply
of Tetanus and Diphtheria Toxoids and of Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine" in the
March 16, 2001, issue of Morbidity and Mortality Weekly Report (MMWR).

The text of the notice reads as follows:

*****************************

During the last quarter of 2000, the U.S. Public Health Service learned of a
shortage of tetanus and diphtheria toxoids (Td) and tetanus toxoid (TT) resulting from
decreased production of these vaccines by the two U.S. manufacturers. Previously published recommendations outlined
priorities for use of the limited supply of Td and TT. The shortage was expected to be
resolved by early 2001; however, on January 10, 2001, Wyeth Lederle (Pearl River, New York)
announced it had stopped production of tetanus toxoid-containing products. Although a small amount of Td is
produced by the University of Massachusetts for local distribution, Aventis Pasteur (Swiftwater,
Pennsylvania) is now the sole nationwide distributor of Td and TT. Aventis Pasteur is shipping limited quantities of vaccine to assure
a wide distribution of available doses.

In accordance with previous recommendations, priority will be given to clinics
and hospitals that treat acute wounds; continuing to prioritize Td and TT use
will be necessary until supplies are restored. Clinics and hospitals in need
of vaccine for wound care should call Aventis Pasteur, telephone (800) 822-2463. Aventis Pasteur is increasing the
amount of Td production. However, because of the long production time required, the shortage is not
expected to be resolved for 12-18 months.

In addition to Wyeth Lederle discontinuing production of its tetanus and diphtheria toxoids and acellular pertussis
vaccine (DTaP; ACEL-IMUNE), Baxter Hyland Immuno Vaccines (formerly North American Vaccine, Inc.)
(Baltimore, Maryland) is not producing its DTaP vaccine (Certiva). Aventis Pasteur and GlaxoSmithKline (Philadelphia,
Pennsylvania), producers of Tripedia and Infanrix, respectively, are the remaining suppliers of DTaP. On
March 7, 2001, the Food and Drug Administration approved a newly formulated version of Tripedia in one-dose vials without
preservative and with only a trace amount of thimerosal. Approval of this vaccine should improve the
supply of DTaP.

DTaP vaccine is recommended as a five-dose series: three doses given to infants at ages 2, 4, and 6 months, followed
by two booster doses at age 15-18 months and at age 4-6 years. Some vaccine providers may have
difficulties obtaining sufficient supplies of DTaP to vaccinate all children in
their practices. If providers have insufficient quantities of DTaP, priorities
should be given to vaccinating infants with the initial three DTaP doses and,
if necessary, to defer the fourth DTaP dose. However, children should be vaccinated with all other recommended
vaccines according to the Childhood Immunization Schedule. When adequate DTaP supplies are available,
providers should recall for vaccination all children who did not receive the
fourth dose of DTaP. If supplies are sufficient, children aged 4-6 years should
be vaccinated in accordance with existing ACIP recommendations to assure immunity to
pertussis, diphtheria, and tetanus during the elementary school years. CDC is evaluating the situation, and more
guidance will be provided should substantial supply problems occur.

On March 7, 2001, the Food and Drug Administration (FDA) approved a new formulation of Tripedia, a diphtheria and
tetanus toxoids and acellular pertussis (DTaP) vaccine that contains only a trace amount of thimerosal.
According to FDA, Tripedia now contains less than 0.5 micrograms of mercury per dose, a greater than 95% reduction in the amount
of thimerosal per dose compared to the original version of Tripedia.

According to Dr. Bernard Schwetz, Acting Principal Deputy Commissioner, "This approval is significant because now all
routinely recommended pediatric vaccines will be available as either completely thimerosal free or without any
significant amounts of thimerosal, a preservative that contains mercury."

Further information about thimerosal is available from FDA by calling (888) 463-6332 (888-INFO-FDA)
or by visiting CDC's website at: www.cdc.gov/nip/vacsafe/concerns/thimerosal/thimerosal.htm
(link discontinued).
------------------------------------------------------------

Each year, CDC produces a variety of recommendations and training materials for the prevention and management of
infectious and chronic diseases. Many of these materials (in print, video, and electronic formats)
offer Continuing Medical and Nursing Education credit. CDC needs physicians and nurses to volunteer to review and evaluate these
materials before their release.

Volunteers will have the opportunity to review CDC technical materials several
times a year. Volunteers will decide which, if any, materials to evaluate. If you
are interested in being included in future requests for reviewers, email the
CDC Continuing Education unit at ce@cdc.gov

Don't miss this opportunity to review cutting-edge CDC
materials--including ACIP statements--before they are released to the public!
------------------------------------------------------------

National Infant Immunization Week (NIIW) will be celebrated April 22-28, 2001, and the Health Promotion Branch of CDC's
National Immunization Program (NIP) can help you prepare. NIP has developed a two-page flyer to
be used in planning for NIIW.

The NIIW kits, which were produced in 1999, are still available on the NIIW website to download or order through
May 1, 2001. NOTE: Be sure to use the new 2001 Immunization Schedule and do not use any information on rotavirus
vaccine.

(5)
March 16, 2001
CDC PUBLISHES REPORT ON LYME DISEASE IN THE UNITED STATES

CDC published a report titled "Lyme Disease--United States, 1999" in the March 16, 2001, issue of MMWR.

According the Editorial Note, the incidence of Lyme disease increased 1.7-fold from 1991 to 1999 and most cases continue
to occur in northeastern, mid-Atlantic, and north central states. The Note states that Lyme disease (LD)
"can be prevented by avoiding tick-infested areas, using repellents, and promptly removing ticks that become attached to clothing
or the body. A vaccine for persons aged 15-70 years, approved by the Food and Drug
Administration in 1998, is 76% effective in preventing LD after three doses."

HOW TO OBTAIN A FREE ELECTRONIC SUBSCRIPTION TO THE MMWR:
To obtain a free electronic subscription to the Morbidity and Mortality Weekly
Report (MMWR), visit CDC's MMWR website at: http://www.cdc.gov/mmwr
Select "Free MMWR Subscription" from the menu at the left of the screen. Once you have
submitted the required information, weekly issues of the MMWR and all new ACIP statements (published as MMWR's
"Recommendations and Reports") will arrive automatically by e-mail.